2025 HCPCS code CF
(Deleted) Effective Date: N/A Revision Date: N/A Deletion Date: N/A ESRD-related AMCC tests - Modifiers Feed
Automated Multi-Channel Chemistry (AMCC) test ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable.
The medical necessity of the AMCC test must be justified based on the individual patient's clinical condition and the specific information needed for diagnosis or management of their ESRD.Simply being a dialysis patient does not automatically qualify all AMCC tests for separate reimbursement; the test must be beyond the usual scope of routine dialysis care.
The ordering physician (either at the ESRD facility or an MCP physician) is responsible for appending the appropriate modifier (previously CD, CE, or CF) to the AMCC test.
In simple words: When a dialysis patient needs certain blood tests, this code tells Medicare that the test isn't covered by the usual dialysis payment and should be paid for separately.
This modifier is used with automated multi-channel chemistry (AMCC) tests for End-Stage Renal Disease (ESRD) patients undergoing maintenance dialysis. It indicates that the specific AMCC test is not included in the ESRD facility's composite rate payment and is therefore separately reimbursable by Medicare.It is used when a provider orders tests for chronic dialysis for ESRD, such as an AMCC test, that are not part of the composite rate. These tests are separately billable and may be ordered by an ESRD facility or Monthly Capitation Payment (MCP) physician.
Example 1: An ESRD patient receiving maintenance dialysis requires a specialized AMCC test not routinely included in the composite rate. The physician orders the test and appends modifier CF (prior to April 1, 2015) to indicate separate reimbursement., A patient with chronic kidney disease undergoing dialysis needs an AMCC test for monitoring electrolyte levels that are not typically part of the composite rate package.The nephrologist orders the test with modifier CF (before the deletion date) so it can be billed separately to Medicare., An ESRD facility provides a series of AMCC tests to a patient, some of which are included in the composite rate and others that are not. Prior to April 1, 2015, they would append modifier CF to only those tests not part of the composite rate to ensure accurate billing and reimbursement.
Documentation supporting the medical necessity of the AMCC test should be included in the patient's medical record. This should clearly state the clinical rationale for ordering the specific test and how it relates to the patient's ESRD condition and dialysis treatment.
** This information pertains to historical billing practices.For current billing information regarding ESRD-related AMCC tests, consult up-to-date Medicare guidelines and coding resources.The provided response is valid as of today's date, December 1, 2024, and might not reflect future coding updates.
- Payment Status: Invalid
- Specialties:Nephrology
- Place of Service:"End-Stage Renal Disease Treatment Facility", "Independent Laboratory"